title: Pathogen-specific risk of celiac disease following bacterial causes of foodborne illness: a retrospective cohort study.
abstract: BACKGROUND
  The US CDC recently estimated over 2 million foodborne illnesses annually are caused by 4 major enteropathogens: non-typhoid Salmonella spp., Campylobacter spp., Shigella spp., and Yersinia enterocolitica. While recent data suggest functional gastrointestinal disorders are associated with these infections, studies linking foodborne illness to celiac disease (CD) are limited. We utilized a US Department of Defense medical encounter database to evaluate the risk of CD following select foodborne infections.
  
  
  METHODS
  We identified subjects with acute gastroenteritis between 1998 and 2009 attributed to Salmonella (nontyphoidal) spp., Shigella spp., Campylobacter spp., or Y. enterocolitica and matched each with up to 4 unexposed subjects. Exposed and unexposed subjects were followed for incident CD diagnosis for their entire military record duration (or a minimum of 1 year). Relative risks were calculated using modified Poisson regression to determine the relationship between pathogen-attributable gastroenteritis and CD while controlling for covariates.
  
  
  RESULTS
  A total of 1,753 pathogen-specific gastroenteritis cases (Campylobacter: 738; Salmonella: 624; Shigella: 376; Yersinia: 17) were identified and followed for a median of 3.8 years. The incidence (per 100,000 person-years) of CD was 0.05. We found a suggested risk of CD after Campylobacter, but not other foodborne infection etiologies.
  
  
  CONCLUSIONS
  These data support a previous study demonstrating increased risk of CD following Campylobacteriosis and highlight the need for additional research into how infections might trigger CD in susceptible individuals.
authors.affiliation: Enteric Diseases Department, Infectious Disease Directorate, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD, 20910-7500, USA, mark.riddle@med.navy.mil.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Riddle
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Murray
authors.forename: Brooks D
authors.initials: BD
authors.lastname: Cash
authors.forename: Mark
authors.initials: M
authors.lastname: Pimentel
authors.forename: Chad K
authors.initials: CK
authors.lastname: Porter
mesh_terms: D000328:Adult; D001419:Bacteria / Q000145:classification*; D001424:Bacterial Infections / Q000382:microbiology; D002446:Celiac Disease / Q000382:microbiology*; D015331:Cohort Studies; D005260:Female; D005516:Food Microbiology; D005517:Foodborne Diseases / Q000382:microbiology*; D005759:Gastroenteritis / Q000382:microbiology*; D006801:Humans; D008297:Male; D008889:Military Personnel; D012189:Retrospective Studies; D055815:Young Adult